Discussion
This study represents the first comprehensive analysis of personal payments to all neurology CPG authors from major pharmaceutical companies in Japan. We demonstrated that over 80% of neurology CPG authors received nearly $14.0 million in personal payments over five years. These payments were for lectures at company-sponsored events, consulting services, and supervising pamphlets about the companies’ products distributed to physicians and patients. Notably, all CPG chairpersons and vice chairpersons had substantially financial ties with pharmaceutical companies.
These close financial relationships between Japanese neurology CPG authors and pharmaceutical companies raise concerns about the Japanese Society of Neurology’s management of financial COIs for CPG authors. This situation may also pose a risk to the credibility and integrity of neurology CPGs in Japan. The high proportions of CPG authors receiving personal payments and the substantial payments to CPG chairpersons during the CPG development and/or a few years after CPG publication indicate clear deviations from international COI policies. According to recommendations by the U.S. National Academy of Medicine and the Guidelines International Network,1,2 medical societies and organizations responsible for producing CPGs should maintain a majority of authors free from financial COIs and appoint chairpersons without such conflicts. However, our findings reveal that none of the CPGs developed by the Japanese Society of Neurology met these recommendations.
The deviations of Japanese CPGs from international COI policies are not unique to neurology but are also evident across specialties in Japan, as previously reported.3-7,18,20-26 Studies have shown that the proportion of CPG authors with financial COIs ranged from 86.4% in cardiology27 to 91.3-100% in rheumatology.4,28 These high proportions may be attributed to less transparent and rigorous COI management policies among Japanese professional medical societies,4,5including the Japanese Society of Neurology. The Japanese Society of Neurology only required authors to declare payments exceeding $4,682 (500,000 Japanese yen) per year per company for activities such as lecturing, consulting, and writing. Thus, payments below this threshold were not mandated to be declared, despite the majority of US and European medical societies requiring disclosure of all payments regardless of amount.14 Given the significant influence of CPGs on clinical practice and patient care, more transparent and rigorous COI management policies as well as enforcement of the policies are essential for future CPGs developed by the Japanese Society of Neurology.
This study has limitations. The payment data were extracted from a secondary database maintained by an independent research organization. As the organization acknowledged, the study cannot rule out the possibility of errors or misreporting in the payment data reported in the database. Additionally, payments from pharmaceutical companies not affiliated with the JPMA were not disclosed, preventing assessment of the full extent of financial relationships between CPG authors and non-JPMA affiliated companies.